Connor McPartland

We present a 60-year-old female with a history of interstitial cystitis who underwent simple cystectomy with orthotopic neobladder creation. Her postoperative course was complicated by a neovesicoc...

Introduction: Robotic-assisted laparoscopic bladder neck reconstruction is a useful option for definitive surgical management of a bladder neck contracture or vesicourethral anastomotic stenosis in patients who underwent prior robotic prostatectomy. The purpose of this video is to demonstrate a reproducible technique for robotic-assisted laparoscopic management of post-prostatectomy vesicourethral anastomotic stenosis via a transvesical approach. Materials and Methods: We demonstrate a step-by-step video on robotic-assisted laparoscopic bladder neck reconstruction in a 55-year-old patient who developed a vesicourethral anastomotic stenosis after prior robotic prostatectomy. This technique involves a circumferential excision of the fibrotic scar and creation of a mucosa-to-mucosa, watertight, tension-free anastomosis between the bladder neck mucosa and posterior urethra. Results: Intraoperatively, there was evidence of a short 5 Fr vesicourethral anastomotic stenosis. Operative time was 103 minutes and estimated blood loss was 100 milliliters. There were no intraoperative complications. There was a negative leak test after filling the bladder with 150 cc of normal saline. Length of stay was 1 day. The patient’s suprapubic catheter (placed preoperatively for urethral rest) was removed intraoperatively. The patient’s catheter was removed on postoperative day 7. There were no major (Clavien >2) postoperative complications. Postoperatively, the patient had a successful trial of void and did not experience postoperative incontinence. Conclusions: Robotic-assisted laparoscopic bladder neck reconstruction may be utilized for definitive management in patients with bladder neck contractures and vesicourethral anastomotic stenosis. Author Disclosure Statement: Matthew Lee and Connor McPartland have no competing financial interests. Daniel Eun is a paid speaker, consultant, and proctor for Intuitive Surgical, a shareholder of Melzi Corp and has received trainee support from Hitachi Medical. Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5min 0 sec.

Clinical History: Endoscopic management of extensive isolated tumor burden within a bladder diverticulum is technically difficult. Physical Exam: The patient presented with gross hematuria. Diagnosis: We describe the case of a 70-year-old male with history of high-grade T1 nonmuscle invasive bladder cancer who was referred for management of extensive tumor burden found within a left lateral wall bladder diverticulum. Intervention: We describe our approach for robotic partial cystectomy via a transvesical approach for management of tumor burden within a bladder diverticulum. After a vertical cystotomy was made along the midline at the dome of the bladder, the left lateral wall diverticulum was identified. Electrocautery was used to circumferentially incise the bladder diverticulum until perivesical fat was encountered. The opening of the bladder diverticulum was closed with braided absorbable suture to reduce the risk of tumor spillage. Once the diverticulum was dissected free off the perivesical fat, the bladder defect was closed in two layers using braided absorbable suture. The cystotomy was closed in a two-layer running fashion and was confirmed to be water-tight. Follow-Up/Outcomes: Operative time was 91 minutes and estimated blood loss was 25 mL. There were no intraoperative complications, and the patient was discharged on the same day with a Foley catheter in place. Postoperative pathology demonstrated high-grade Ta nonmuscle invasive bladder cancer. The patient had a successful trial of void 2 weeks postoperatively and has not experienced any postoperative complications. Robotic partial cystectomy via a transvesical approach may be utilized for management of tumor burden within a bladder diverticulum. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the institutional review board at Temple University (protocol number 20793). M.L., C.M., and J.J. have no conflicts of interest to disclose. D.E. is founder of Melzi corp and a consultant for Intuitive Surgical and Johnson and Johnson: . Runtime of video: 4 mins 15 secs

We received the critique of our article ¹ Woodward S.G. Rios-Diaz A.J. Zheng R. et al. Finding the most favorable timing for cholecystectomy after percutaneous cholecystostomy tube placement: an analysis of institutional and national data. J Am Coll Surg. 2021; 232 : 55-64 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar from Sakamoto and Lefor and appreciate the feedback. In their letter to the editor, Sakamoto and Lefor identified 3 main points of clarification within our article, with the first questioning the exclusion of patients undergoing cholecystectomy within the same admission of percutaneous cholecystostomy tube (PCT) placement, the second point addressing patients with retained common bile duct stones postoperatively as it relates to PCT timing, and finally, using a linear assumption in analyzing the relationship between surgical complications and duration of PCT. We would like to address these points.

Astaxanthin (ASX) is a marine-based ketocarotenoid; an accessory pigment in plants in that it has many different potential functions. ASX is an antioxidant that is notably more potent than many other antioxidants. Antioxidants have anti-inflammatory and oxidative stress-reducing properties to potentially reduce the incidence of cancer or inhibit the expansion of tumor cells. In this study, we tested the hypothesis that ASX would inhibit proliferation and migration of breast cancer cells in vitro. We found that application of ASX significantly reduced proliferation rates and inhibited breast cancer cell migration compared to control normal breast epithelial cells. Based on these results, further investigation of the effects of ASX on not only breast cancer cells, but other forms of tumor cells, should be carried out.